What You’ll Learn
The main impediment in overcoming the burdens of PA faced by payers and providers isn’t lack of automation, it’s broken business process.
Drug prior authorization programs (PA) have been in existence for many years and have evolved over time. Most commonly deployed MCO PA strategies for specialty medications still incite active debate between plan sponsors (i.e., employers), physician providers and patients as to the ability of these programs to increase safety and decrease costs.
This white paper will help you better understand what is going on behind the curtain for PAs in both the medical and pharmacy benefit, including when they are needed (or not) and how they can align more effectively with other utilization management strategies.
In this market analysis and insights paper we cover:
- An overview of the pros and cons of commonly used prior authorization programs with an emphasis on drugs billed through the medical benefit
- The implications to MCOs, plan sponsors, physicians, and patient stakeholders
- New approaches to prior authorization that represent an opportunity to improve return on investment, promote operational efficiency and deliver optimal clinical outcomes.
- The use of alternative metrics to identify measurable value for delivering effective drug utilization and cost controls.
Report insights presented in collaboration
with NICH founding company Access Market Intelligence